Lack of Durable Remission with Conventional-Dose Total Skin Electron Therapy for the Management of Sezary Syndrome and Multiply Relapsed Mycosis Fungoides

Autor: Robert Twigger, Odette Buelens, Christopher McCormack, H. Miles Prince, Gail Ryan, Belinda A. Campbell, Eleanor Tangas, Mathias Bressel, Carrie van der Weyden
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Cancers, Vol 11, Iss 11, p 1758 (2019)
Cancers
Volume 11
Issue 11
ISSN: 2072-6694
Popis: Mycosis fungoides (MF) and Sezary syndrome (SS) are multi-relapsing, morbid, cutaneous T-cell lymphomas. Optimal treatment sequencing remains undefined. Total skin electron therapy (TSE) is a highly technical, skin-directed treatment, uniquely producing symptom-free and treatment-free intervals. Recent publications favour low-dose TSE for reduced toxicity, but early data support conventional-dose TSE (cdTSE) for longer disease control. Patient selection requires weighing-up tolerability against response durability. We investigated duration of benefit from cdTSE in patients with poorer prognosis diseases: SS and heavily pre-treated MF. Endpoints were overall survival, and &ldquo
time to next treatment&rdquo
(TTNT) as surrogate for clinical benefit duration. Seventy patients (53 MF, 17 SS) were eligible: median prior treatments, 4
median cdTSE dose, 30 Gy
median follow-up, 5.8 years. SS patients had worse prognosis (HR = 5.0, p <
0.001) and shorter TTNT (HR = 4.5, p <
0.001) than MF patients
median TTNT was only 3.7 months. Heavily pre-treated MF patients had inferior prognosis (HR = 1.19 per additional line, p = 0.005), and shorter TTNT (HR = 1.13 per additional line, p = 0.031). Median TTNT for MF patients with &ge
3 prior treatments was 7.1 months, versus 23.2 months for 0&ndash
2 prior treatments. In conclusion, cdTSE has a limited role in SS. TTNT is reduced in heavily pre-treated MF patients, suggesting greater benefit when utilized earlier in treatment sequencing.
Databáze: OpenAIRE
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